Updated diagnostic criteria for neuromyelitis optica spectrum disorder: Similar outcomes of previously separate cohorts

Background

The specificity of the aquaporin-4 antibody to predict recurrent inflammatory central nervous system disease has led to the design of the 2015 neuromyelitis optica spectrum disorder criteria which capture all aquaporin-4 antibody seropositive patients.

Objective

The purpose of this study was to compare treatment outcomes in aquaporin-4 antibody seropositive patients who met the previous 2006 clinical criteria for neuromyelitis optica with patients who meet the 2015 neuromyelitis optica spectrum disorder criteria.

Methods

The study involved a three-center retrospective chart review of clinical outcomes among aquaporin-4 patients diagnosed with neuromyelitis optica and neuromyelitis optica spectrum disorder.

Results

Hazard ratios of relapse during immunosuppressive therapy, relative to pre-therapy, were not significantly different for patients who met the 2006 criteria of neuromyelitis optica versus the 2015 neuromyelitis optica spectrum disorder criteria among those treated with azathioprine ( p = 0.24), mycophenolate mofetil ( p = 0.63), or rituximab ( p = 0.97).

Conclusion

Reductions in the hazard of relapse during treatment with immunosuppressive therapies, relative to average pre-treatment, were not different for aquaporin-4 antibody seropositive patients categorized using the 2006 criteria of neuromyelitis optica and the 2015 neuromyelitis optica spectrum disorder criteria. These therapeutic findings support the design of the 2015 neuromyelitis optica spectrum disorder criteria which capture all aquaporin-4 antibody seropositive patients.

Requirement for safety monitoring for approved multiple sclerosis therapies: an overview

During the last two decades, treatment options for patients with multiple sclerosis (MS) have broadened tremendously. All agents that are currently approved for clinical use have potential side effects, and a careful risk-benefit evaluation is part of a decision algorithm to identify the optimal treatment choice for an individual patient. Whereas glatiramer acetate and interferon beta preparations have been used in MS for decades and have a proven safety record, more recently approved drugs appear to be more effective, but potential risks might be more severe. The potential complications of some novel therapies might not even have been identified to their full extent. This review is aimed at the clinical neurologist in that it offers insights into potential adverse events of each of the approved MS therapeutics: interferon beta, glatiramer acetate, mitoxantrone, natalizumab, fingolimod and teriflunomide, as well as recently approved therapeutics such as dimethyl fumarate and alemtuzumab. It also provides recommendations for monitoring the different drugs during therapy in order to avoid common side effects.

Methodology for demonstrating and measuring the photocytotoxicity of fluoranthene to fish cells in culture

Methodology was developed for quantifying the photocytotoxicity of fluoranthene to a gill cell line from rainbow trout for future use in screening polycyclic aromatic hydrocarbons for their relative photocytotoxicity to fish. Solubilization in a modified culture medium was achieved with and without foetal bovine serum (FBS) and with and without dimethyl sulfoxide (DMSO). FBS caused most of the fluoranthene to remain in solution and blocked photocytotoxicity if present during UV irradiation. DMSO had little effect on fluoranthene distribution in cell cultures but caused cells to be slightly more sensitive to the phototoxicity of fluoranthene. The indicator dyes alamar Blue() and 5-carboxyfluorescein diacetate acetoxymethyl ester were used to quantify cytotoxicity in two different ways-singly in two separate assays, and mixed together in a novel single assay, which saved time and material. With UV irradiation for 2 hr at a photon fluence rate of either 1.4 mumol UV-B/m(2)/sec (UV-A:UV-B, 1.5) or 1.1 mumol UV-B/m(2)/sec (UV-A:UV-B, 9.7), both dyes indicated increasing loss of viability with increasing doses of fluoranthene. EC(50) values ranged from 18 to 44 ng/ml (89-217 nM), with the alamar Blue assay being slightly more sensitive.

Associations between retinal nerve fiber layer abnormalities and optic nerve examination

OBJECTIVE

Retinal nerve fiber layer (RNFL) abnormalities detected by optical coherence tomography (OCT) are useful markers for axonal loss and visual dysfunction in multiple sclerosis (MS), but their role in routine clinical management is not well-studied.

METHODS

Clinical and OCT examinations were performed on 240 patients attending a neurology clinic. Using OCT 5th percentile to define abnormal RNFL thickness, we compared eyes classified by neurologists as having optic atrophy to RNFL thickness, and afferent pupillary defect (APD) to RNFL thickness ratios of eye pairs.

RESULTS

Mean RNFL thickness was less in eyes classified by neurologists as having optic atrophy (79.4 ± 21 μm; n=63) vs those without (97.0 ± 15 μm; n=417; p < 0.001, t test) and in eyes with an APD (84.1 ± 16 μm; n=44) than without an APD (95.8 ± 17 μm; n=436; p < 0.001). Physicians' diagnostic accuracy for detecting pallor in eyes with an abnormal RNFL thickness was 79% (sensitivity=0.56; specificity=0.82). Accuracy for detecting a RAPD in patients with mean RNFL ratio (affected eye to unaffected eye) <0.90 was 73% (sensitivity=0.30; specificity=0.86). Ability to detect visual pathway injury via assessment of atrophy and APD differed between neurologists.

CONCLUSIONS

OCT reveals RNFL abnormality in many patients in whom eyes are not classified by neurologic examiners as having optic atrophy. Further study is needed to define the role of OCT measures in the context of examinations for optic atrophy and APD by neuroophthalmologists. OCT-measured RNFL thickness is likely to have an important future role in the clinical setting.

Vitamin D status and effect of low-dose cholecalciferol and high-dose ergocalciferol supplementation in multiple sclerosis

BACKGROUND

Vitamin D is important for bone health and immune regulation, and has been shown to be low in multiple sclerosis (MS). We sought to determine the effect of over the counter low dose cholecalciferol (LDC) and high dose ergocalciferol (HDE) on the vitamin D levels in MS patients.

METHODS

We retrospectively evaluated serum 25-hydroxy-vitamin D [25(OH)D] levels of 199 patients (CIS, n = 32; RRMS, n = 115; PPMS, n = 10; SPMS, n = 16; Transverse Myelitis (TM), n = 9; other neurological diseases, n = 16) attending our clinic between 2004 and 2008. We examined the change in 25(OH)D levels in 40 MS patients who took either LDC (< or =800 IU/day) or HDE (50,000 IU/day for 7-10 days, followed by 50,000 IU weekly or biweekly).

RESULTS

The average 25(OH)D level was 71 +/- 39 nmol/L (Mean +/- SD), and 167(84%) patients had insufficient levels (< or =100 nmol/L) of 25(OH)D. The patients supplemented with LDC did not have a significant increase in their 25(OH)D levels. However, 25(OH)D levels increased by 42 nmol/L (P = 0.01) in the patients originally taking LDC and then prescribed HDE. Optimal levels (> or =100 nmol/L) were only achieved in less than 40% of patients.

CONCLUSIONS

We conclude that large numbers of patients with MS and TM in our cohort are deficient in vitamin D. HDE significantly elevated 25(OH)D levels in MS patients and was more effective at increasing 25(OH)D levels than LDC. Prospective studies are required to determine appropriate dosing regimen to achieve optimal levels in the majority of MS patients and to ascertain the safety, immunological response, and ultimately the clinical efficacy of vitamin D replacement therapy.

Idiopathic transverse myelitis: corticosteroids, plasma exchange, or cyclophosphamide

Transverse myelitis is a focal disorder of the spinal cord in which an immune-mediated process results in neural injury. In this large retrospective study, we compare patients who received one of four treatments to identify the most effective therapies. We identified subsets of patients who received clinical benefit from plasma exchange or cyclophosphamide being included in their treatment regimen.

Synergistic effects of a photooxidized polycyclic aromatic hydrocarbon and copper on photosynthesis and plant growth: evidence that in vivo formation of reactive oxygen species is a mechanism of copper toxicity

Heavy metals and polycyclic aromatic hydrocarbons (PAHs) are often cocontaminants in industrialized environments, yet little is known about either the extent or mechanisms of their cotoxicity. To address this shortfall, the combined effects of an oxygenated PAH, 1,2-dihydroxyanthraquinone (1,2-dhATQ), and a heavy metal, Cu2+, on photosynthesis and growth of the duckweed (Lemna gibba) were evaluated. Using assays of chlorophyll a fluorescence and photosystem I activity, 1,2-dhATQ inhibited electron transport at the cytochrome b6/f complex. Conversely, Cu2+ alone (at low concentrations) had little effect on photosynthesis. When Cu2+ was combined with 1,2-dhATQ, an increase in transient and steady-state chlorophyll a fluorescence quenching occurred relative to 1,2-dhATQ alone. Treatment of isolated thylakoid membranes with 1,2-dhATQ inhibited whole-chain linear electron transport, measured as O2 consumption using methyl viologen as the electron acceptor. However, Cu2+ plus 1,2-dhATQ resulted in active O2 consumption with or without methyl viologen as an electron acceptor. From these data, we conclude that 1,2-dhATQ renders the plastoquinone pool to a highly reduced state by inhibiting at cytochrome b6/f. Then, Cu2+ is able to mediate the transfer of electrons from reduced plastoquinone to O2, forming reactive oxygen species. At the whole-organism level, when Cu2+ and 1,2-dhATQ were mixed at concentrations that resulted in the above-mentioned impacts on photosynthesis, synergistic inhibition of plant growth was observed. This suggests a catalytic mechanism of toxicity for redox active metals, a process that could be instrumental in explaining their impacts at low concentrations.

Synergistic effects of a photooxidized polycyclic aromatic hydrocarbon and copper on photosynthesis and plant growth: evidence that in vivo formation of reactive oxygen species is a mechanism of copper toxicity

Heavy metals and polycyclic aromatic hydrocarbons (PAHs) are often cocontaminants in industrialized environments, yet little is known about either the extent or mechanisms of their cotoxicity. To address this shortfall, the combined effects of an oxygenated PAH, 1,2-dihydroxyanthraquinone (1,2-dhATQ), and a heavy metal, Cu2+, on photosynthesis and growth of the duckweed (Lemna gibba) were evaluated. Using assays of chlorophyll a fluorescence and photosystem I activity, 1,2-dhATQ inhibited electron transport at the cytochrome b6/f complex. Conversely, Cu2+ alone (at low concentrations) had little effect on photosynthesis. When Cu2+ was combined with 1,2-dhATQ, an increase in transient and steady-state chlorophyll a fluorescence quenching occurred relative to 1,2-dhATQ alone. Treatment of isolated thylakoid membranes with 1,2-dhATQ inhibited whole-chain linear electron transport, measured as O2 consumption using methyl viologen as the electron acceptor. However, Cu2+ plus 1,2-dhATQ resulted in active O2 consumption with or without methyl viologen as an electron acceptor. From these data, we conclude that 1,2-dhATQ renders the plastoquinone pool to a highly reduced state by inhibiting at cytochrome b6/f. Then, Cu2+ is able to mediate the transfer of electrons from reduced plastoquinone to O2, forming reactive oxygen species. At the whole-organism level, when Cu2+ and 1,2-dhATQ were mixed at concentrations that resulted in the above-mentioned impacts on photosynthesis, synergistic inhibition of plant growth was observed. This suggests a catalytic mechanism of toxicity for redox active metals, a process that could be instrumental in explaining their impacts at low concentrations.

Effects of ultraviolet-A exposure on ultraviolet-B-induced accumulation of specific flavonoids in Brassica napus

Many plant species are able to acclimate to changes in ultraviolet-B radiation (UVB) (290-320 nm) exposure. Due to the wide range of targets of UVB, plants have evolved diverse repair and protection mechanisms. These include increased biosynthesis of UVB screening compounds, elevated antioxidant activity and increased rates of DNA repair. We have shown previously that Brassica napus L. cv Topas plants can acclimate quite effectively to environmentally relevant increases in UVB through the accumulation of specific flavonoids in the leaf epidermis. However, B. napus was found to lose other flavonoids when plants are exposed to ultraviolet-A radiation (UVA) (320-400 nm) and/or UVB (Wilson et al. [1998] Photochem. Photobiol. 67, 547-553). In this study we demonstrate that the levels of all the extractable flavonoids in the leaves of B. napus plants are decreased in a dose-dependent manner in response to UVA exposure. Additionally, the accumulation of the extractable flavonoids was examined following a shift from photosynthetically active radiation (PAR) + UVA to PAR + UVB to assess if preexposure to UVA affected UVB-induced flavonoid accumulation. UVA preexposures were found to impede UVB-induced accumulation of some flavonoids. This down regulation was particularly evident for quercetin-3-O-sophoroside and quercetin-3-O-sophoroside-7-O-glucoside, which is interesting because quercetins have been demonstrated to be induced by UVB and correlated with UVB tolerance in some plant species. The photobiological nature of these UVA-mediated effects on flavonoid accumulation implies complex interactions between UVA and UVB responses.

Effects of a pre-incubation period on the photoinduced toxicity of polycyclic aromatic hydrocarbons to the luminescent bacterium Vibrio fischeri

Irradiation of polycyclic aromatic hydrocarbons (PAHs) in aqueous solution with simulated solar radiation (SSR; a light source with a visible light: UV-A:UV-B ratio similar to that of sunlight) can greatly enhance their toxicity. Two microbial toxicity tests with Vibrio fischeri were used to investigate the effect of composition of the growth medium and pre-incubation on the photoinduced toxicity of PAHs. The assays were a short-term test (15 min) and long-term test (18 h). Both assays were carried out in SSR and darkness to examine for photoinduced toxicity of PAHs. For the short-term toxicity assay, inhibition of bacterial luminescence was measured. For the long-term toxicity assay, both inhibition of bacterial luminescence and inhibition of growth were recorded. To broaden this test, V. fischeri cells were pre-incubated with PAHs in medium without a carbon source (minimal medium) for 8 h to facilitate assimilation and photooxidation of the contaminants, and to prevent bacterial growth at the outset of the assay. V. fischeri was more sensitive in minimal medium than in complex medium in both the short- and long-term toxicity assays. Moreover, in the long-term assay, SSR greatly increased toxicity, especially if there was a pre-incubation period in minimal medium. This indicates that both assimilation and photooxidation of PAHs are important to their toxicity to V. fischeri.

Chlorophyll fluorescence as a bioindicator of effects on growth in aquatic macrophytes from mixtures of polycyclic aromatic hydrocarbons

Chlorophyll-a fluorescence induction is a rapid technique for measuring photosynthetic electron transport in plants. To assess chlorophyll-a fluorescence as a bioindicator of effects of polycyclic aromatic hydrocarbon mixtures, chlorophyll-a fluorescence parameters and plant growth responses to exposure to the wood preservative creosote were examined in the aquatic plants Lemna gibba and Myriophyllum spicatum. Exposure to creosote inhibited growth of L. gibba (EC50 = 7.2 mg/L total polycyclic aromatic hydrocarbons) and M. spicatum (EC50 = 2.6 mg/L) despite differences in physiology. Creosote also diminished maximum PSII efficiency (Fv/Fm) (EC50 = 36 and 13 mg/L for L. gibba and M. spicatum) and the effective yield of photosystem II photochemistry (deltaF/Fm') (EC50 = 13 and 15 mg/L for L. gibba and M. spicatum). The similarity between growth and chlorophyll-a fluorescence EC50s and slopes of the response curves suggests a close mechanistic link between these end points. The predictive power of chlorophyll-a fluorescence as a bioindicator of whole-organism effects applied to complex contaminant mixtures is discussed.

Control of asgE expression during growth and development of Myxococcus xanthus

One of the earliest events in the Myxococcus xanthus developmental cycle is production of an extracellular cell density signal called A-signal (or A-factor). Previously, we showed that cells carrying an insertion in the asgE gene fail to produce normal levels of this cell-cell signal. In this study we found that expression of asgE is growth phase regulated and developmentally regulated. Several lines of evidence indicate that asgE is cotranscribed with an upstream gene during development. Using primer extension analyses, we identified two 5' ends for this developmental transcript. The DNA sequence upstream of one 5' end has similarity to the promoter regions of several genes that are A-signal dependent, whereas sequences located upstream of the second 5' end show similarity to promoter elements identified for genes that are C-signal dependent. Consistent with this result is our finding that mutants failing to produce A-signal or C-signal are defective for developmental expression of asgE. In contrast to developing cells, the large majority of the asgE transcript found in vegetative cells appears to be monocistronic. This finding suggests that asgE uses different promoters for expression during vegetative growth and development. Growth phase regulation of asgE is abolished in a relA mutant, indicating that this vegetative promoter is induced by starvation. The data presented here, in combination with our previous results, indicate that the level of AsgE in vegetative cells is sufficient for this protein to carry out its function during development.

Protection of photosystem II against UV-A and UV-B radiation in the cyanobacterium Plectonema boryanum: the role of growth temperature and growth irradiance

Plectonema boryanum UTEX 485 cells were grown at 29 degrees C and 150 mumol m-2 s-1 photosynthetically active radiation (PAR) and exposed to PAR combined with ultraviolet-A radiation (UV-A) at 15 degrees C. This induced a time-dependent inhibition of photosystem II (PSII) photochemistry measured as a decrease of the chlorophyll a fluorescence ratio, Fv/Fm, to 50% after 2 h of UV-A treatment compared to nontreated control cells. Exposure of the same cells to PAR combined with UV-A + ultraviolet-B radiation (UV-B) caused only a 30% inhibition of PSII photochemistry relative to nontreated cells. In contrast, UV-A and UV-A + UV-B irradiation of cells cultured at 15 degrees C and 150 mumol m-2 s-1 had minimal effects on the Fv/Fm values. However, cells grown at 15 degrees C and lower PAR irradiance (6 mumol m-2 s-1) exhibited similar inhibition patterns of PSII photochemistry as control cells. The decreased sensitivity of PSII photochemistry of P. boryanum grown at 15 degrees C and 150 mumol m-2 s-1 to subsequent exposure to UV radiation relative to either control cells or cells grown at low temperature but low irradiance was correlated with the following: (1) a reduced efficiency of energy transfer to PSII reaction centers; (2) higher levels of a carotenoid tentatively identified as myxoxanthophyll; (3) the accumulation of scytonemin and mycosporine amino acids; and (4) the accumulation of ATP-dependent caseinolytic proteases. Thus, acclimation of P. boryanum at low temperature and moderate irradiance appears to confer significant resistance to UV-induced photoinhibition of PSII. The role of excitation pressure in the induction of this resistance to UV radiation is discussed.

Fractional simplex designs for interaction screening in complex mixtures

In mixture experiments, one may be interested in estimating not only main effects but also some interactions. Main effects and significant interactions in a mixture may be estimated through appropriate mixture experiments, such as simplex-centroid designs. However, for mixtures with a large number of factors, the run size for these designs becomes impractically large. A subset of a full simplex-centroid design may be used, but the problem remains regarding which factor-level settings should be selected. In this paper, we propose a solution that considers design points with either one or p individual nonzero factor-level settings. These fractional simplex designs provide a means of screening for interactions and of investigating the behavior of many-component mixtures as a whole while greatly reducing the run size compared with full simplex-centroid designs. The means of construction of the design arrays is described, and designs for < or = 31 factors are presented. Some of the proposed methodology is illustrated using generated data.

The effect of creosote on the growth of an axenic culture of Myriophyllum spicatum L

Due to the importance of submersed, rooted macrophytes to the aquatic ecosystem and the use of creosote impregnated structures adjacent to or within water bodies, a study was conducted using an axenic culture of Myriophyllum spicatum to determine the effect of creosote on this aquatic macrophyte. Four plants were cloned and exposed to nominal creosote concentrations ranging from 0.16 to 200 mg/l for 14 days. A variety of response parameters were assessed, including shoot and root length, number of roots and nodes, and dry weight biomass, as well as visual observations on plant colouring and morphology. Regression and ANOVA analyses were conducted to determine EC50s and significant differences. Biphasic responses were observed for shoot length, node production and biomass, with shoot length showing statistically significant stimulation (hormesis) at creosote concentrations below 13.3 mg/l. EC50 values of 55.1 (CI 40-60) mg/l, 33.4 (CI 26-48) mg/l and 86 (CI 70-120) mg/l were determined for shoot length, dry weight and node production, respectively. Root number was significantly higher at 3.6 mg/l and root length was significantly reduced at 4.5 mg/l creosote, within the concentration range that stimulated shoot growth. Visual changes, including an increase in pink colouration and changes in the location of root initiation, were also observed in the same creosote concentration range that affected root length and numbers. Therefore, it appears that changes in root growth and location of root initiation may be the most sensitive endpoints for creosote effects on Myriophyllum.

Pathway of anthracene modification under simulated solar radiation

Exposure of polycyclic aromatic hydrocarbons (PAHs) to sunlight results in rapid structural photomodification generally via oxidation reactions. These PAH modification products are in many cases more toxic than their parent compounds. In this study, anthracene (ANT), a rapidly photooxidized PAH, was irradiated with simulated solar radiation (SSR, 100 micromol m(-2) s(-1)) in aqueous solution to examine the photomodification pathway. The photoproducts formed were identified by HPLC. The ANT product profile after 9 h in SSR was very complex, with more than 20 compounds detected. The photoproducts formed were anthraquinones, benzoic acids, benzaldehydes and phenols showing the process to be oxidative in nature. Some of the anthraquinones were themselves subject to photooxidation, and were thus intermediates in the product pathway. The kinetics of ANT photooxidation revealed a pseudo first-order reaction with a half-life of 2 h under the SSR source used. The kinetics of product formation allowed deduction of a probable photomodification pathway. This study indicates that PAH photooxidation products are likely to exist as complex, dynamically changing mixtures in PAH contaminated aquatic environments.

Intact and photomodified polycyclic aromatic hydrocarbons inhibit photosynthesis in natural assemblages of Lake Erie phytoplankton exposed to solar radiation

Recently, there has been a trend toward less turbid water and greater light penetration in parts of western Lake Erie. This could lead to greater phototoxicity from sediment-bound polycyclic aromatic hydrocarbons. To test photosynthesis as a bioindicator of contaminant impacts on algae, water samples containing natural assemblages of phytoplankton were collected from the western and central basins of Lake Erie. These samples were incubated with 0.2 to 2 mg L(-1) anthracene or its photomodified product 1, 2-dihydroxyanthraquinone for 60 min in darkness or in 50% sunlight, to mimic exposure of phytoplankton in the photic zone of a mixed water column. Photosynthetic efficiency was determined from filtered phytoplankton immediately after exposure using a pulse-amplitude modulated chlorophyll fluorometer. Phytoplankton incubated with chemicals in the dark demonstrated chlorophyll fluorescence values similar to those of controls. However, exposure to anthracene or 1, 2-dihydroxyanthraquinone in sunlight diminished photosystem II photosynthetic efficiency and photosynthetic quantum yield in a concentration-dependent manner. Anthracene inhibited photosynthesis at lower concentrations than 1,2-dihydroxyanthraquinone, which is consistent with the different modes of action and toxic strengths of these two contaminants. These results demonstrate that phytoplankton in Lake Erie can be subject to phototoxicity from intact and photomodified polycyclic aromatic hydrocarbons after very short exposures. Further, chlorophyll fluorescence was found to be an effective bioindicator in the field for this form of chemical stress.

Ability of polycyclic aromatic hydrocarbons to induce 7-ethoxyresorufin-o-deethylase activity in a trout liver cell line

Along with 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD), 24 unsubstituted polycyclic aromatic hydrocarbons (PAHs) were evaluated for their ability to induce 7-ethoxyresorufin-o-deethylase (EROD) activity in the rainbow trout liver cell line RTL-W1. When the duration and cell density of exposure were increased, the EC(50) for EROD induction was relatively constant for TCDD, but increased for PAHs. Regardless of exposure conditions, EROD activity was not induced by 9 PAHs: naphthalene, phenanthrene, anthracene, pyrene, perylene, acenaphthylene, acenaphthene, fluorene, and fluoranthene. Two PAHs, benzo[g,h,i]perylene and coronene, induced EROD activity inconsistently. The remaining 13 PAHs consistently induced EROD activity. The EC(50)s for induction exhibited approximately a 110-fold range. The order of potency, from most to least potent, was benzo[k]fluoranthene, dibenzo[a,i]pyrene, dibenzo [a,h]anthracene, benzo[a]pyrene, indeno[1,2,3-cd]pyrene, benzo [b]fluoranthene, pentacene, benzo[b]anthracene, benzo[b] fluorene, chrysene, benzo[a]anthracene, benzo[e]pyrene, and triphenylene. When the induction potency was expressed relative to TCDD, the toxic equivalency factors (TEFs) ranged from 0.001 to 0.000 01. When expressed relative to benzo[a]pyrene, the TEFs ranged from 3.44 to 0. 03.

Impacts of structural photomodification on the toxicity of environmental contaminants: anthracene photooxidation products

The toxicity of polycyclic aromatic hydrocarbons (PHAs) is known to be enhanced by light via photosensitization reactions (production of active oxygen) and photomodification of the chemicals (e.g., oxidation) to more toxic compounds. Anthracene (ANT) toxicity in particular has been found to increase dramatically following photomodification. The objective of this study was to identify the photooxidation products of ANT and assess the toxicity of selected photoproducts. High performance liquid chromatography (HPLC) analysis of anthracene photooxidation revealed a complex array of oxidation products; prevalent among these were anthraquinone (ATQ) and hydroxy-anthraquinones (hATQs). Eleven of these compounds were tested for toxicity using growth inhibition of the duckweed Lemna gibba L. G-3. All but one of the compounds tested were found to be toxic, and when UV radiation was present in the light source toxicity was generally enhanced. The chemicals were also irradiated under SSR prior to toxicity testing. In about half the cases, the ATQ compounds were rapidly photooxidized and the resultant photoproducts were more toxic than the parent compounds. Interestingly, 2-hydroxyanthraquinone, which was not subject to photooxidation, was the most toxic of the compounds tested. As a light stable compound it presents the risk of a persistent environmental hazard.

Ability of 16 priority PAHs to be directly cytotoxic to a cell line from the rainbow trout gill

Sixteen polycyclic aromatic hydrocarbons (PAHs) were screened for their ability to be directly cytotoxic to a cell line from the rainbow trout gill, RTgill-W1. Exposure times of 2 h or less were sufficient for direct cytotoxicity to be detected, which appeared to be caused by a common mechanism, the general perturbation of membranes. This was judged by the similarity of results obtained for three fluorescent indicator dyes, alamar Blue, 5-carboxyfluorescein diacetate acetoxymethyl ester (CFDA-AM) and neutral red. Among the 16 PAHs tested, just two- and three-ring PAHs were found to be directly cytotoxic. These were naphthalene approximately = acenaphthylene approximately = acenaphthene > fluorene approximately = phenanthrene. The results suggest that water solubility and lipophilicity are the critical properties determining the direct cytotoxicity of PAHs and that they do so by influencing PAH accumulation in membranes. Only naphthalene was effective at concentrations well below its water solubility limit. Therefore, direct cytotoxicity is likely to be most environmentally relevant only with naphthalene.

Ability of 16 priority PAHs to be photocytotoxic to a cell line from the rainbow trout gill

Sixteen polycyclic aromatic hydrocarbons (PAHs) were screened for their ability to be photocytotoxic to a cell line from the rainbow trout gill, RTgill-W1. PAHs could be divided into one of three groups: incapable of being photocytotoxic, able to be both photocytotoxic and directly cytotoxic, or capable of being only photocytotoxic. Photocytotoxicity was distinct from direct cytotoxicity in that EC50 values were lower with the neutral red assay immediately after the PAH/UV treatment than with alamar Blue or CFDA-AM, indicating a more specific action on lysosomes. As well, in photocytotoxicity but not in direct cytotoxicity, the three assays showed increased impairment 24 h after treatment. Most PAHs were found to be strictly photocytotoxic; however, only six compounds were photocytotoxic at concentrations theoretically achievable in water. When photocytotoxic PAHs were ranked relative to fluoranthene to establish fluoranthene equivalent factors (FEFs), benzo[a]pyrene and benzo[g,h,i]perylene were found to be most potent. However, when the water solubility of each compound was taken into account in order to calculate the potential environmental photocytotoxic potency (PEPP), fluoranthene and pyrene appeared to have the most potential to impact fish through photocytotoxicity.

Amelioration of the photo-induced toxicity of polycyclic aromatic hydrocarbons by a commercial humic acid

The ability of a commercial (Aldrich Chemical Co.) humic acid (AHA) to ameliorate the photo-induced toxicity of polycyclic aromatic hydrocarbons (PAHs) was examined using Lemna gibba L. (G3). Plants were exposed to anthracene and benzo(a)pyrene both with and without AHA and grown under visible light as well as lighting that simulates relative abundances of UV-A and UV-B in natural sunlight (SSR). Modest additions of 1.6 mg.L-1 AHA were sufficient to ameliorate the photo-induced toxicity of 2 mg.L-1 anthracene by improving growth rates to nearly 50% of controls and inducing minor recovery from complete chlorosis in the most highly affected plants. Benzo(a)pyrene induced minor, but significant, chlorosis under SSR, and AHA additions always increased growth rate and chlorophyll content, although to less of a degree than anthracene toxicity under SSR. The protective effects of AHA on anthracene toxicity increased linearly with increases in AHA concentrations up to 6.2 mg.L-1. Slopes of these relationships changed in the presence of UV light relative to visible light treatments; thus UV changed the extent to which AHA mediates PAH toxicity. However, the net effect was still for AHA to ameliorate PAH photo-induced toxicity even though UV has the potential to photooxidize AHA and enhance the production of potentially toxic reactive oxygen species from AHA photosensitization.

Photoinduced toxicity of PAHs to the foliar regions of Brassica napus (canola) and Cucumbis sativus (cucumber) in simulated solar radiation

Simulated solar radiation and natural sunlight can enhance polycyclic aromatic hydrocarbon (PAH) toxicity, previously reported in terms of inhibited production of Lemna gibba leaves and diminished growth of Brassica napus seedling roots. This work has been extended to examine the photoinduced impact of PAHs on the foliar regions of terrestrial plants. To carry out these experiments two crop species, B. napus (canola) and Cucumbis sativus (cucumber), were chosen to test the photoinduced toxicity of six PAHs (anthracene, phenanthrene, benzo(a)anthracene, benzo(a)pyrene, flouranthene, and pyrene). Aqueous solutions containing PAHs were sprayed on the foliage of the plants. It was found that all the PAHs tested had negative impacts on the foliage of the plants and the concentrations that induced toxicity were consistent with those observed for inhibition of growth of L. gibba. The impacts were observed as diminished biomass accumulation, induction of chlorosis, and inhibition of photosynthesis. It may be concluded from this work that PAHs in rain and surface waters could be harmful to photosynthetic tissues of terrestrial plants.

Photoinduced effects of polycyclic aromatic hydrocarbons on Brassica napus (Canola) during germination and early seedling development

It has recently been demonstrated that light dramatically enhances the toxicity of polycyclic aromatic hydrocarbons (PAHs) to the duckweed Lemna gibba L. G-3 (L. Ren, X.-D. Huang, B.J. McConkey, D.G. Dixon, and B.M. Greenberg, 1994, Ecotoxicol. Environ. Saf. 28, 160-171). To extend this research to terrestrial plants, Brassica napus L. (oil seed rape) seeds were germinated in the presence of three PAHs; anthracene (ANT), benzo[a]pyrene (BAP), and fluoranthene. The chemicals were applied both in intact form and following photomodification in UV-B radiation; toxicity was assessed in simulated solar radiation (SSR), a light source with a visible light:UV-A:UV-B ratio similar to that of sunlight. Germination efficiency, root and shoot growth, and chlorophyll content, measured after 6 days of exposure, were used as toxicity endpoints. Intact and photomodified PAHs had little impact on shoot fresh weight or chlorophyll content, but markedly inhibited root fresh weight, with the photomodified PAHs having greater impacts than the intact PAHs. The decline in root fresh weight was not attributable to a decline in germination frequency or delayed germination. However, the seedlings produced shorter roots in the presence of either intact or photomodified PAHs. To explore the role of actinic radiation on PAH toxicity, seedlings were incubated in SSR, visible light and darkness with either intact or photomodified PAHs. Inhibition of root growth was only achieved by the intact chemicals if actinic radiation was present. However, with photomodified ANT or photomodified BAP, root fresh weight accumulation was inhibited in SSR, visible light and darkness. Thus, intact PAHs are hazardous to terrestrial plants in the presence of light, but once the compounds are photomodified, actinic radiation is no longer an absolute requirement for phytotoxic activity.

Increased polycyclic aromatic hydrocarbon toxicity following their photomodification in natural sunlight: impacts on the duckweed Lemna gibba L. G-3

The authors previously demonstrated that simulated solar radiation (SSR), with a fluence rate of only 40 mumol m-2 sec-1, increased polycyclic aromatic hydrocarbon (PAH) toxicity to the duckweed Lemna gibba and that PAHs photomodified in SSR (generally oxygenation of the ring system) are more toxic than the parent compounds (Huang et al., Environ. Toxicol. Chem., 1993, 12, 1067-1077). It is not known, however, to what extent toxicity of PAHs can increase due to photomodification. Thus, natural sunlight, which has a high fluence rate (approximately 2000 mumol m-2 sec-1), was used to photomodify anthracene, benzo[a]pyrene, fluoranthene, phenanthrene, and pyrene. Toxicity was based on growth inhibition of L. gibba, measured as the rate of production of new leaves over an 8-day period. Initially, the toxicity of the PAHs applied in intact form was probed, with the compounds demonstrating greater toxicity in sunlight than in SSR. Next the PAHs were photomodified in sunlight prior to incubation with the plants. The half-lives of the PAHs in sunlight ranged from 12 min to 30 hr. Although most of the products of PAH photomodification are not yet identified, the degree that PAH toxicity increased following photomodification in sunlight could still be probed. The mixtures of photomodified chemicals that were derived from each PAH in sunlight were applied of L. gibba and growth inhibition under 100 mumol m-2 sec-1 of SSR was determined. The LC50s for the PAH photoproducts generated in sunlight were an order of magnitude lower than the LC50s for the PAHs applied in intact form.

In Vivo Photomodification of Ribulose-1,5-Bisphosphate Carboxylase/Oxygenase Holoenzyme by Ultraviolet-B Radiation (Formation of a 66-Kilodalton Variant of the Large Subunit)

Increased levels of solar ultraviolet (290-320 nm) (UV-B) radiation could have profound effects on plant proteins because the aromatic amino acids in proteins absorb strongly in this spectral region. We have investigated the effects of UV-B radiation on plant proteins and have observed a novel 66-kD protein. This product was formed in vivo when Brassica napus L. plants grown for 21 d in 65 [mu]mol m-2 s-1 photosynthetically active radiation were subsequently exposed to 65 [mu]mol m-2 s-1 photosynthetically active radiation plus UV-B radiation (1.5 [mu]mol m-2 s-1). The protein appeared after 4 h of UV-B irradiation and accumulated during the next 16 h in UV-B. The 66-kD protein cross-reacted with an antiserum against the ribulose-1,5-bisphosphate carboxylase/oxygenase (Rubisco) holoenzyme. Analysis of soluble leaf proteins revealed that the 66-kD product had a number of isoforms corresponding closely to those of the large subunit of Rubisco (LSU). Partial proteolytic digests of the LSU and the 66-kD protein resulted in an equivalent pattern of protein fragments, leading to the conclusion that the 66-kD protein was a photomodified form of the LSU. A similar high molecular mass variant of Rubisco was observed in soluble protein extracts from leaves of tomato (Lycopersicon esculentum), tobacco (Nicotiana tabacum), and pea (Pisum sativum L.) plants treated in vivo with UV-B, suggesting that it might be a common product, at least among C3 plants. It is interesting that the 66-kD product appears to be generated after incorporation of the LSU into holoenzyme complexes. This conclusion was drawn from two lines of evidence. First, the LSU variant co-purified with holoenzyme complexes isolated by nondenaturing polyacrylamide gel electrophoresis. Second, a UV-B-specific 66-kD protein did not accumulate in a tobacco mutant that synthesizes the Rubisco subunits but does not assemble them into normal holoenzyme complexes.

Photoinduced toxicity of three polycyclic aromatic hydrocarbons (fluoranthene, pyrene, and naphthalene) to the duckweed Lemna gibba L. G-3

The authors recently demonstrated that light dramatically enhances the hazards of three polycyclic aromatic hydrocarbons (PAHs), anthracene, phenanthrene, and benzo[a]pyrene, to the duckweed Lemna gibba L. G-3 (X.-D. Huang, D. G. Dixon, and B. M. Greenberg, 1993, Environ. Toxicol. Chem., 12, 1067-1077). To extend this research, growth and chlorosis were used as end points to assess the photoinduced toxicity of three additional PAHs, fluoranthene, pyrene, and naphthalene, to L. gibba in the presence of simulated solar radiation (a light source with a UV-B: UV-A:visible light ratio equivalent to that of sunlight). The phytotoxicity of these three PAHs was photoactivated, with ultraviolet radiation being the only spectral region that enhanced the harmful effects of the chemicals. Dose-response curves based on chemical concentration and light intensity revealed that the order of phytotoxic strength was fluoranthene > pyrene > naphthalene. To explore whether photomodification (in addition to photosensitization) of fluoranthene, pyrene, and naphthalene could contribute to photoinduced toxicity, the chemicals were irradiated prior to (as opposed to simultaneously with) application to the plans. The rates of photomodification of the three PAHs were rapid enough for the photooxidized compounds to contribute to toxicity, and the photomodified PAHs were more toxic than the parent compounds. As well, toxicity could be correlated to photomodification; impacts increased in parallel with the extent of photomodification.

Specificity and Photomorphogenic Nature of Ultraviolet-B-Induced Cotyledon Curling in Brassica napus L

Three general classes of photomorphogenic photoreceptors have been characterized in higher plants: phytochrome, a blue light/ultraviolet (UV)-A photoreceptor(s), and a UV-B sensory system(s). Although a great deal is known about phytochrome and the blue light/UV-A photoreceptor(s), little is known about UV-B detection processes. One reason for this is the lack of readily quantifiable morphogenic responses that are specifically induced by UV-B radiation. We have discovered a response to UV-B, upward curling of Brassica napus L. cotyledons, that may be useful for probing the mechanism of UV-B photoreception. The process was initially observed when B. napus seeds were germinated under visible light plus UV-B radiation, but did not occur under visible light alone or visible light plus UV-A. When 5-d-old seedlings grown in visible light were given relatively short exposures of UV-B (100 min of 5.5 [mu]mol m-2 s-1), the curling response was also observed. Development of curling was separated from the application of this UV-B pulse by a 14-h latent period. Pulses of red light, blue light, farred light, and UV-A (100 min of 5.5 [mu]mol m-2 s-1) did not induce curling, indicating UV-B specificity Additionally, these other spectral regions did not reverse or enhance the UV-B-triggered response. The degree of curling showed a log-linear dependence on UV-B fluence (6-40 mmol m-2) and reciprocity with respect to length of exposure and fluence rate. The data indicate that curling is photomorphogenic in nature and may be triggered by a single photoreceptor species.

A preliminary report on the use of laser-Doppler flowmetry during tethered spinal cord release

Neurological deterioration in the tethered cord syndrome has been postulated to result from a compromise of blood flow in the distal spinal cord. In order to evaluate vascular perfusion in human subjects, a new technique of laser-Doppler flowmetry was used to monitor continuously the microcirculation of the distal spinal cord during surgery for tethered cord release in 10 children. For further comparison, five children undergoing selective dorsal rhizotomy were also monitored. In the tethered cord syndrome group, spinal cord blood flow before untethering was a mean of 12.6 ml/min per 100 g of tissue and increased in all cases after release to a mean of 29.4 ml/min per 100 g of tissue. All patients improved neurologically. The selective dorsal rhizotomy group had a preoperative mean spinal cord blood flow of 30.8 ml/min per 100 g of tissue, which was not altered by the operative procedure. Significant improvement occurs in distal spinal cord blood flow after tethered cord release, which may be representative of an important mechanism in the pathophysiology of the tethered cord syndrome.

A socioeconomic analysis of digital replantations resulting from home use of power tools

Forty-seven digits in 21 patients who sustained partial or complete amputations from the home use of power tools were replanted or revascularized during a 1-year period. This represented 69% of the microvascular surgery performed for hand injuries during that year. The cost of repairing an average of 2.4 digits was $7000 (surgeon's fee) plus $697 per hour (operating room fee), as per fiscal year 1987. Postoperative hospitalization averaged 15 days at a cost of $15,679. Hand rehabilitation averaged 8 months at a cost of $3348. Fifty-four percent of the patients had no insurance. Fourteen of 21 patients (67%) required at least one additional procedure. Two patients had to make a career change after the injury. The majority of patients with digital replantations were dissatisfied with the emotional costs and the number of subsequent operations. Lack of patient and family awareness of the length of the rehabilitative period was particularly evident.

Use of an inferiorly based rectus muscle flap in flank wound coverage

An inferiorly based rectus island flap was used to repair a large infected hip wound resulting from treatment of a posteriorly dislocated-comminuted acetabular fracture. The muscle island flap (based on the inferior epigastric vessels) allowed an extended arc of rotation to cover this laterally located wound.

Differential Synthesis of Photosystem Cores and Light-Harvesting Antenna during Proplastid to Chloroplast Development in Spirodela oligorrhiza

Proplastids and etioplasts are common starting points for monitoring chloroplast development in higher plants. Although proplastids are the primary precursor of chloroplasts, most proplastid to chloroplast systems are cumbersome to study temporally. Conversely, the etioplast to chloroplast transition is initiated by light and is readily examined as a function of time. Etioplasts, however, are found mostly in plants germinated in the dark and are not an obligatory step in chloroplast development. We have chosen to study chloroplast ontogeny in Spirodela oligorrhiza (Kurtz) Hegelm (a C(3)-monocot) because of its unique ability to grow indefinitely in the dark. Ultrastructural, physiological, and molecular evidence is presented in support of a temporal, light-triggered proplastid to chloroplast transition in Spirodela. The dark-grown plants are devoid of chlorophyll, and upon illumination synchronously green over a 3- to 5-day period. Synthesis of chloroplast proteins involved in photosynthesis is coincident with thylakoid assembly, chlorophyll accumulation, and appearance of CO(2) fixation activity. Interestingly, the developmental sequence in Spirodela was slow enough to reveal that biosynthesis of the D1 photosystem II reaction center protein precedes biosynthesis of the major light-harvesting antenna proteins. This, coupled with the high chlorophyll a/b ratio observed early in development, indicated that reaction center assembly occurred prior to accumulation of the light-harvesting complexes. Thus, with Spirodela one can study proplastid to chloroplast conversions temporally in higher plants and follow the process on a time scale that enables a detailed dissection of plastid maturation processes.

Congenital bifid sternum: repair in early infancy and literature review

Sternal clefting is an unusual congenital anomaly that should be repaired in early infancy. Early surgery is facilitated by a highly compliant bony thorax. The surgical technique is described, including the (1) removal of a wedge at the confluence of the two lateral sternal bands to allow their apposition, (2) intraoperative assessment of pulmonary compliance and central venous pressure, (3) use of bilateral pectoral flaps, and (4) resulting avoidance of major costochondral stair-step osteotomies. The suggested age of repair is 1 to 4 weeks of age.

Avianca flight No. 052 accident: a plastic surgical perspective

The crash of Avianca Airlines flight no. 052 en route to JFK Airport on January 25, 1990, in Cove Neck, New York, resulted in the death of 72 passengers. Eighty-nine victims were admitted to 13 regional hospitals. Despite difficult access to the wooded crash site, early warning and prompt response by 37 volunteer fire and rescue units resulted in organized EMS triage and rapid hospital transport. This report reviews the specific injuries incurred, highlights the team management approach to a major aviation accident in a suburban area, and studies the likelihood of accidents of this magnitude. Thirty-eight patients triaged to two level I trauma centers, North Shore University Hospital-Cornell University Medical Center and Nassau County Medical Center, form the basis of this report. Seventeen patients were male; 21 were female. The average patient age was 33 years. Eight patients were children. The average length of stay was 30.9 days (range 2 to greater than 90 days). Twenty-six patients (including nonsurvivors) (68 percent) sustained significant multiple orthopedic injuries. The majority of fractures were open grade II to III tibia-fibula fractures. Bilaterality was commonly seen. Soft-tissue coverage of open long bone fractures was required in 10 patients (11 extremities) and included 3 microvascular muscle transfers, 7 muscle transposition flaps, and 3 skin grafts. Seven patients required open reduction and fixation of complex facial fractures (two of Le Fort II to III type, four of complex naso-orbital-ethmoid type). Plastic surgical repair of complex lacerations was common. Peripheral nerve exploration was required in three patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Efficacy of intraarterial heparin in maintaining microvascular patency: an experimental model

Human-grade sodium heparin was studied to determine thrombosis model patency rates between an intraarterial infusion versus an intravenous method of delivery in a rabbit model. Specific differences in patency and partial thromboplastin times were studied in each group and compared with a saline-perfused group. Three animal groups (New Zealand white rabbits) were established (total = 35 animals). Standardized femoral arterial 5-mm inversion grafts (AIG) were done in each animal in each group. The animals in the control group received intravenous saline infusion, while the two treatment groups received intravenous heparin (12 animals) or intraarterial heparin (12 animals minus 1 anesthesia death). The route of instillation of the infusate was selected at random after completing the inversion grafts. A proximal epigastric branch was utilized for access in those animals randomized to the intraarterial group. Intravenous delivery was accomplished by means of a femoral venous catheter in the vena cava. A 72-hour period of infusion was used in all animals. A dose of 45 units per hour of heparin following a 500-unit bolus was used in the intravenous group. After an identical bolus dose, 25 units per hour of heparin was administered in the intraarterial group. The control (saline group) was given 1 cc saline (in a volume equal to the heparin-dosed groups) daily for 3 days. Arterial inversion graft patency rates were assessed by direct inspection at day 5. Systemic and regional (i.e., distal to the inversion graft) partial thromboplastin times (PTT) were measured in representative control, IV, and intraarterial heparin-treated groups. Complications were recorded.(ABSTRACT TRUNCATED AT 250 WORDS)

D1-D2-cytochrome b559 complex from the aquatic plant Spirodela oligorrhiza: correlation between complex integrity, spectroscopic properties, photochemical activity, and pigment composition

A D1-D2-cyt b559 complex with about four attached chlorophylls and two pheophytins has been isolated from photosystem II of the aquatic plant Spirodela oligorrhiza and used for studying the detergent-induced changes in spectroscopic properties and photochemical activity. Spectral analyses (absorption, CD, and fluorescence) of D1-D2-cyt b559 preparations that were incubated with different concentrations of the detergent Triton X-100 indicate two forms of the D1-D2-cyt b559 complexes. One of them is photochemically active and has an absorption maximum at 676 nm, weak fluorescence at 685 nm, and a strong CD signal. The other is photochemically inactive, with an absorption maximum at 670 nm, strong fluorescence at 679 nm, and much weaker CD. The relative concentrations of the two forms determine the overall spectra of the D1-D2-cyt b559 preparation and can be deduced from the wavelength of the lowest energy absorption band: preparations having maximum absorption at 674, 672, or 670.5 nm have approximately 20, 60, or 85% inactive complexes. The active form contains two chlorophylls with maximum absorption at 679 nm and CD signals at 679 (+) and 669 nm (-). These chlorophylls make a special pair that is identified as the primary electron donor P-680. The calculated separation between the centers of these two pigments (using an extended version of the exciton theory) is about 10 A, the pigments' molecular planes are tilted by about 20 degrees, and their N1-N3 axes are rotated by 150 degrees relative to each other. The other two chlorophylls and one of the two pheophytins in the D1-D2-cyt b559 complex have their maximum absorption at 672 nm, while the maximum absorption of the photochemically active pheophytin is probably at 672-676 nm. During incubation with Triton X-100, the photochemically active complex is transformed into an inactive form with first-order kinetics. In the inactive form the maximum absorption of the 679 nm absorbing Chls is blue-shifted to 669 nm. The first-order decay of the photochemical activity suggests that the isolated D1-D2-cyt b559 complex is stable as an aggregate but becomes unstable on dissociation into individual D1-D2-cyt b559 units.

Comparative bacterial clearances of muscle and skin/subcutaneous tissues with and without dead bone: a laboratory study

Seventeen New Zealand White rabbits underwent implantation of three different concentrations of bacteria and a sterile saline control solution with and without dead autologous bone in eight separate muscular and eight separate subcutaneous sites. Following a period of 1 week, each site was surgically explored and samples of tissue were taken for histology and quantitative culture. Results reveal that final bacterial concentrations in the subcutaneous sites were significantly lower than in the muscle sites (p less than or equal to 0.0001) for each concentration of bacteria, with and without dead bone. Dead bone resulted in very significantly greater bacterial concentrations in both subcutaneous and muscle sites. Clinically, these results indicate that a thorough bony wound debridement is more important than the type of tissue used to close the wound. Flap tissue should be selected with regard to the perfusion, contour, and appearance of the recipient site.

Separate photosensitizers mediate degradation of the 32-kDa photosystem II reaction center protein in the visible and UV spectral regions

A component of the photosystem II reaction center, the 32-kDa protein, is rapidly turned over in the light. The mechanism of its light-dependent metabolism is largely unknown. We quantified the rate of 32-kDa protein degradation over a broad spectral range (UV, visible, and far red). The quantum yield for degradation was highest in the UVB (280-320 nm) region. Spectral evidence demonstrates two distinctly different photosensitizers for 32-kDa protein degradation. The data implicate the bulk photosynthetic pigments (primarily chlorophyll) in the visible and far red regions, and plastoquinone (in one or more of its redox states) in the UV region. A significant portion of 32-kDa protein degradation in sunlight is attributed to UVB irradiance.

Correlation of postoperative bone scintigraphy with healing of vascularized fibula transfer: a clinical study

This study examines the usefulness and reliability of bone scintigraphy in correlation with radiological and clinical evidence of bone healing in 15 patients who underwent microvascular transfer of the fibula. All patients were followed for a minimum of 18 months postoperatively. Technetium-99 methylene diphosphonate bone scans and the most recent radiographs were blindly rereviewed. Bone scintigraphic results were characterized as (1) clearly positive (i.e., excellent visualization of the fibula), (2) clearly negative (i.e., no evidence of tracer uptake in the fibula), or (3) indeterminate (i.e., artifact present as a result of metallic or soft tissue interference). Bone radiographs were classified into three typical patterns: (1) complete bony union and graft hypertrophy, (2) incomplete union (either distal or proximal) requiring a second procedure), and (3) nonunion, with increased proximal and distal lucency (with or without pathological fracture) and loss of graft definition. Eleven patients had positive scintigraphic scans postoperatively. In 8 no subsequent procedure was necessary; 2 patients required additional bone grafts to augment the osseous reconstruction; viable fibulas were seen at reoperation. One patient with a positive scan showed decreased graft definition at four months followed by autograft fracture. Three patients had indeterminate scans, 2 of whom evidenced uncomplicated clinical and radiological union. One patient had a clearly negative scan and ultimately tibia-fibula synostosis was required to attain stability. Bone scintigraphy appears to correlate with survival, but not necessarily union, of a vascularized fibula autograft. Additional monitoring techniques should be used in combination with a one-time bone scan to both monitor the patency of the microanastomoses and to prioritize the orthopedic management of the patient.

St. Clair Strange procedure: indications, technique, and long-term evaluation

The pedicled ulnar nerve transfer (St. Clair Strange procedure) preserves the intrinsic blood supply to the transferred nerve and allows bridging of large defects in avascular, scarred wounds. We report our indications for this operation, describe the two operative stages, and report the results in seven patients. After operation progressive median nerve axonal growth in a proximal direction up the ulnar nerve was shown by a median nerve Tinel's sign. Five patients followed for a mean of 10 years achieved protective sensibility in the median nerve distribution. In two of the three patients in whom distal nerve repair was done to the median and ulnar nerve, protective sensibility also returned to the ulnar digits. Localization, stereognoses, and vibratory response was achieved in the majority of digits. All patients had active use of the hand, but none had meaningful two-point discrimination. No changes were found after a superficial radial nerve block excluded any radial nerve contribution. No intrinsic motor functional return was noted. Two patients are currently being followed.

Therapeutic value of intravenous heparin in microvascular surgery: an experimental vascular thrombosis study

In an attempt to decrease a 10 to 15 percent vascular thrombosis rate leading to graft occlusion, low-dose human-grade heparin was studied to determine if carefully monitored intravenous therapy would increase 7-day patency in a known potent thrombosis model. In New Zealand white rabbits, the type of infusate administered intravenously, either saline (30 animals) or heparin (35 animals), was selected at random after completing a 2-mm arterial inversion graft in the femoral artery. A 72-hour infusion was used in all animals; the control group received sterile saline and the experimental group received a heparin infusion at 45 microliters per hour after a 500-unit bolus. All grafts in both groups were patent at the time of groin closure. Patency in the heparin-perfused group was 67 percent (24 of 35) as compared to 19 percent (6 of 30) in the control group (p less than 0.05) 1 week postoperatively. Scanning electron microscopy showed significantly less dense fibrin deposition and a decrease in the number of aggregated platelets in the heparin-perfused grafts. Partial tissue thromboplastin time values in the experimental group ranged between 55 and 75 seconds (control 20 to 25 seconds). We have shown that heparin, an inexpensive and readily available agent, maintains 1-week microarterial patency and results in few complications in a reliable, reproducible, and versatile thrombosis model. The clinical ramifications of using an antiplatelet agent that diminishes fibrin deposition in microsurgery are apparent.

Interpositional vein grafts to restore the superficial palmar arch in severe devascularizing injuries of the hand

The use of an interpositional vein graft to restore inflow to the digits by recreating the superficial palmar arch is presented. This technique is best reserved for severe, devascularizing injuries to the hand, significant damage to the palmar vessels, and when they may a paucity of donor vein available.

Great toe-to-hand transfer: role of the preoperative lateral arteriogram of foot

This report correlates the results of the lateral angiogram of the foot with the operative dissection and eventual outcome in 29 patients in whom a great toe-to-hand transfer was performed to treat a traumatic loss of the thumb. Our angiographic findings were confirmed by surgical exploration and indicated that (1) in 20 (70%) of 29 patients the first dorsal metatarsal artery (FDMA) originated from the dorsalis pedis artery, dorsal to the midlongitudinal axis of the first metatarsal bone; (2) in 6 (20%) of 29 patients the FDMA originated from the dorsalis pedis artery, plantar to the midlongitudinal axis of the first metatarsal bone; (3) in the remaining 3 (10%) of 29 patients the arteriogram of the lateral foot indicated that the plantar metatarsal artery supplied the great toe in a dominant pattern, necessitating its use as the donor vessel; and (4) the measured lumenal diameters of the dorsal and plantar metatarsal arteries (mean diameter = 1.30 mm and 1.27 mm, respectively) did not significantly differ. The lateral views of the foot were helpful in permitting distinct identification of the location and size of the metatarsal arteries to the great toe.

Successful localization of parathyroid adenomas by magnetic resonance imaging

Exploration of the neck for primary hyperparathyroidism is facilitated if the parathyroid glands can be localized preoperatively. Magnetic resonance imaging is a noninvasive and relatively safe procedure that is capable of distinguishing and differentiating small soft-tissue structures. Ten patients with primary hyperparathyroidism underwent preoperative diagnostic magnetic resonance imaging followed by cervical exploration. In 9 of these patients (90 percent), imaging correctly predicted the location of a single enlarged parathyroid gland, and in one patient the findings were misleading. All 10 patients proved to have single adenomas in orthotopic locations. Based on this early experience, magnetic resonance imaging appears to be a promising technique for preoperative localization of an enlarged parathyroid gland.

Identification of a primary in vivo degradation product of the rapidly-turning-over 32 kd protein of photosystem II

The 32 kd photosystem II protein of plant chloroplasts is rapidly turned over in the light. The initial events in the degradation of the 32 kd protein were studied. A 23.5 kd breakdown product was identified in Spirodela oligorrhiza membranes using immunological analysis. The 23.5 kd polypeptide was shown to be derived from the amino-terminal portion of the 32 kd protein using partial proteolytic fingerprinting. An in vivo precursor--product relationship between the 32 kd protein and the 23.5 kd polypeptide was kinetically demonstrated by radiolabeling and pulse-chase experiments. The cleavage site yielding the 23.5 kd polypeptide was localized to a functionally active region (between helices IV and V) of the 32 kd protein. We propose that an alpha-helix-destabilizing 'degradation' sequence, bordered by arginine residues 225 and 238, is involved in the formation of the 23.5 kd polypeptide.

Management of cutaneous melanomas of the female breast

Primary melanomas of the skin of the breast are uncommon lesions. Fifty-four patients were surgically treated for this lesion during a 13-year period, accounting for 3.8 percent of a total of 1431 patients with cutaneous melanoma. Nineteen patients were female and 35 were male. Most recently, in patients with high-risk lesions, such as those exhibiting an aggressive vertical growth phase or a Clark level IV or V, attempts at curative resection have utilized wide and deep excision to the level of the pectoralis fascia with axillary lymph node dissection in selected cases. Reconstruction of the significant breast deficit in five female patients utilized the latissimus dorsi myocutaneous flap. This technique results in an improved aesthetic appearance when compared to primary closure or skin grafting. Donor-site morbidity is minimal. Long-term cancer surveillance is not impeded, and all five patients expressed satisfaction with the reconstruction. Four of the five female patients are currently alive with no evidence of disease at a mean follow-up of 55 months after definitive therapy.

Macrodactyly and the epidermal nevus syndrome

Macrodactyly is an uncommon congenital anomaly that affects the fingers and toes. Speculation as to cause is focused on the association with connective tissue abnormalities, such as neurofibromatosis. We report a highly unusual case of a patient with epidermal nevus syndrome, a specific connective tissue and skeletal disease, who also exhibited bilateral, four finger macrodactyly. Potential causes of linkage between these two specific and unusual syndromes are discussed. Treatment of the epidermal nevus may be nonoperative, differing from the philosophy of aggressive treatment of the similarly appearing premalignant congenital hairy nevus.

Degradation of the 32 kD Herbicide Binding Protein in Far Red Light

White light (400-700 nanometers) supports the activity of photosystem I (PSI) and photosystem II while far red light (>/=700 nanometers) supports PSI almost exclusively. In intact fronds of Spirodela oligorrhiza, turnover of the 32 kilodaltons herbicide binding protein is stimulated under both these light conditions, although not in the dark or at wavelengths >730 nanometers. As is the case in white light, the far red light induced degradation of the protein is inhibited by DCMU. The means by which far red light operates is unclear. Hypotheses considered include: PSI activated proteolysis, PSI-induced formation of semiquinone anions, and PSI-generated free radicals.

Abnormal parathyroid glands: high-resolution MR imaging

High-resolution magnetic resonance (MR) images of the neck were obtained in 23 patients with hyperparathyroidism. Surgical confirmation was available in all cases. MR imaging allowed accurate localization of 14 of 17 parathyroid adenomas, two of two parathyroid carcinomas, and five of eight hyperplastic glands, the latter from three patients. MR depicted nine of 11 (82%) abnormal glands that were 0.5-1.0 cm in size and 12 of 14 (85.7%) glands larger than 1 cm in diameter. In all but one case, abnormal glands had signal intensity greater than or equal to that of fat on spin-echo images with long repetition time and echo time. Parathyroid adenomas, carcinomas, and hyperplasia could not be distinguished from each other. The overall sensitivity and specificity of MR imaging in the detection of parathyroid abnormalities was 77.8% and 95.4% respectively, resulting in an accuracy of 90.2%. This compares favorably with other imaging modalities.